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Friday, November 8, 2013

A fat chance with trans fats...but chance of what?

Well, if they actually do it, the FDA is reported to be all but banning the use of trans fats in food. The idea is that this will be a huge health benefit to society because partially hydrogenated foods are unsafe. According to the piece in the New York Times, "Dr. Margaret A. Hamburg, the agency’s commissioner, said the rules could
prevent 20,000 heart attacks and 7,000 deaths from heart disease each
year."

Source: Wiki Commons

But is this good....or bad....news?
This seems like unambiguously good news. After all, who wants to die of heart disease? And that will save our brobingnagianly expensive health care system lots of money, no? But it could actually be bad news, and here's the inconvenient reason: surprise, surprise, you'll have to die of something!

Heart attacks are fearful events. They often kill quickly, even without warning. That might be a kind way to go. But if you aren't susceptible to heart attacks because your arteries remain clear, then what? The other things that are going wrong all over your body, and they are even if they're silently doing so, will continue. The good side is that you may live longer. The bad side is that you may die more slowly and in a vastly more costly way. Cancer, bone, joint and other physical decay, loss of mobility, the consequences of obesity, and neural degeneration will require expensive diagnostic testing and treatment. Those diseases will develop more slowly, and linger for a long time. Many will require years of institutional care.

This is the ineluctable problem of competing causes, one very clearly understood by public health systems, if not advertised by the medical research and health-care establishment. Costs may balloon out of control if too many live too long in too degenerated a condition. And there are already other bad behaviors which, if we stop eating trans fats, may rise in proportion and do us the same amount of damage, even if in a different way. Even, say, if we live longer and hence drive more at increased ages.

The implications
It's not just that we'll probably live longer on average if we don't suffer from 'transfatism' but we may have to be retired longer. At least for a while, if this ban takes, the retirement age will remain roughly what it's heading for (say, 70?). Even if people are still functional at that age, they'll have expected to be free by then, free to enjoy their final life-stage. But that stage will last longer. That means pensions will have to be paid out longer--regardless of the increased health care cost.

And who will pay for those health-care costs? Oh, no problem, the Affordable Care Act will! That's an illusion. The young will pay for it, because current dollars pay for current expenses, not the dollars the elders put in years ago (which payed for their elders' care). And the young are already likely to be heavily burdened by caring for the normal daily life costs of the huge fraction of our society that will be made of retirees.

It's a real bind. It produces a fundamental tension between individual and population concerns. Individuals mainly want to live as long as they can, but from a population perspective the turnover should not be so slow as to outpace resources. One might think things were different if we had a religion that promised heavenly life thereafter. If we really believed that and we acted according to God's instructions, we should not fear mortality, and should on the contrary be willing to get out of the way so our descendants could have as much chance to life the moral life as possible--not being so squeezed by poverty or deprivation as to act with hate, greed, violence, and so on. Sadly, religion doesn't seem to act that way--at least, societies in which a lot of people profess to believe in the afterlife rewards of a good life lived here, typically don't act any differently from anybody else. Those who may be religious but continue to have large numbers of children violate both views: they don't live morally if that means considering one's fellows, and they risk putting their own offspring in the kinds of squeeze that leads to selfish behavior.

The connections between trans fats and these broader considerations is not as distant as one might think, especially because trans fats are only one of many aspects of our society that have similarly complex consequences.

Nobody would argue that we should advocate heavy smoking, drinking, and trans-fat diets in order to get rid of people earlier in their lives, before they degenerate and develop much more costly diseases. We don't want to wink-out sooner if we Twink-out, but if we Twink-off then we'll spend more time winking off in the ol' rocking chair.

If there are solutions to this problem, rather than some future mass catastrophe, it is that to which the public health establishment should be giving attention. There are no easy answers that we know of. But that is not a reason to be an ostrich and pretend the issues aren't clearly there, waiting for each of us (who shun trans fats!).

4 comments:

I don't mean to oversimplify a complex problem (or perhaps I do), but there's a fairly straightforward solution suggested by this chart. If indeed the top 0.001% of the global population holds 30% of the wealth, the next 0.01% holds 19%, and the next 0.1% holds 32%, the obvious (not easy... just obvious) solution is to place a cap on maximum wealth, tax the rest away and redistribute it. Why? because there is an intrinsic right to be alive, but there is no intrinsic right to hold wealth vastly beyond need. But I am absolutely certain there will be individuals who refuse to see the logic in this... :-)

You're referring to fairness, but not to typical human behavior I fear. High top-level taxation does keep societies more even and doesn't even prevent some from being wealthy. But if those who have control the levers, then we get what we get.

Yes, I'm talking about fairness. I wouldn't even dare to hope, except that the US was once a "[h]igh top-level taxation" society, and the entire economy ran better as a result: you can't run a consumption-driven economy without lots of consumers with money to spend. I continue to hope, not because I think it will happen, but because the sorry state I live in, Texas, has a child poverty rate of about 26%. To quote the late great Duke Ellington, "Things ain't what they used to be."

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